Medicaid expansion associated with lower overall breast cancer mortality

Medicaid expansion is associated with a lower overall breast cancer mortality rate, according to recent findings published in JAMA Network Open. The study found a 4.8% relative reduction in mortality among women living in states that adopted Medicaid expansion compared with those in non-expansion states, highlighting the role of insurance coverage in improving cancer outcomes.

However, disparities still exist when looking at race and ethnicity, the study results show. Hispanic women experienced the greatest reduction in mortality risk at -19.0%, while the benefit was substantially smaller for Black women at -4.3% and White women at -3.4%. These differences underscore longstanding inequities in cancer care access and outcomes across the United States.

Black women continue to face the highest breast cancer mortality rates in the country, approximately 40% higher than those of White women, despite having lower overall incidence rates. Researchers note that this disparity is largely driven by later-stage diagnoses among Black women, which are influenced by social, economic and geographic barriers within the healthcare system.

“These findings support Medicaid expansion as a potentially lifesaving public health policy, particularly for women with breast cancer,” Oluwasegun Akinyemi, M.D., Ph.D., from the Clive O. Callender Outcomes Research Center, Howard University College of Medicine, Washington, DC, writes in the study. “However, the persistence of racial and ethnic disparities, especially among Black women, despite coverage expansion, suggests that insurance alone is insufficient and must be accompanied by targeted interventions to address structural racism, care fragmentation and other social determinants of health.”

For this study, Akinyemi and his team used the National Cancer Database to identify 1,595,845 women ages 40 to 64 with breast cancer. Of these women, 922,862 (57.8%) lived in early-expansion states and 672,983 (42.2%) in non-expansion states. Women were followed up with 7 years later. Medicaid expansion was associated with an overall 4.8% relative hazard reduction in breast cancer patients when compared with women living in non-expansion states.

The largest survival gains were seen in women living in the highest-income neighborhoods (−9.7%), women with metastatic disease (-13.9%) and women receiving immunotherapy (−24.1%).

In the United States, breast cancer is the most common cancer in women and the second leading cause of cancer-related death, behind lung cancer.

Breast cancer is also the most expensive cancer to treat, costing $29.8 billion in 2020.

The Patient Protection and Affordable Care Act (ACA) was enacted in 2010 to address healthcare disparities, allowing patients earning up to 138% of the federal poverty level to receive care. In 2025, this was $21,597 per individual.

As of January 2026, 41 states, including Washington D.C., have expanded Medicaid.

The states that have not adopted expansion are:

• Wyoming
• Texas
• Kansas
• Wisconsin
• Tennessee
• Mississippi
• Alabama
• Georgia
• Florida
• South Carolina

“Further studies should investigate the mechanisms by which Medicaid expansion is associated with reduced mortality, including adherence to guideline-recommended therapies, continuity of care and access to high-quality oncology services,” Akinyemi and his colleagues write in the study. “Longitudinal research is also needed to determine whether the survival benefits associated with expansion persist over time and whether additional policy measures can eliminate residual disparities among Black women and other historically marginalized groups.”